Undiagnosed depression complicates dementia

Nearly 20% of dementia patients have depression

Alzheimer’s patients who are depressed exhibit greater impairment in activities of daily living than other dementia patients, says one researcher. For that reason alone, case managers should evaluate whether depression is affecting their Alzheimer’s patients’ ability to function.

"Alzheimer’s patients who are depressed may not toilet, may not eat, may not dress. If they’re sitting around in a blue funk, it can lead to many serious complications such as malnutrition and decubitus ulcers," says Douglas Holmes, PhD, administrator of research and development at the Hebrew home for the Aged in Riverdale, NY.

Holmes and his colleagues randomly selected 40 to 50 Alzheimer’s residents at each of several nursing homes in New York state. At each nursing home, researchers asked the staff whether they felt the patients were depressed and then conducted lengthy interviews with each patient.

The patient interviews were conducted by research psychiatrists and included evaluation of depression levels, degrees of dementia, cognitive impairments, and other personal characteristics, Holmes says. Researchers found the following:

• Staff estimated that 4% to 5% of dementia patients in their nursing home were depressed.

• Psychiatrists identified a prevalence of depression in those patients of roughly 10%, with an additional 11% exhibiting minor depression.

"That’s an estimate of about 20% of all dementia patients, and it’s probably an underestimate," Holmes says. "And that’s an important quality of life issue. Imagine being demented and then piling totally miserable and depressed on top. It’s horrendousness squared."

It’s also a case management issue. Not only do depressed Alzheimer’s patients suffer from increased functional impairments, they often experience sleep disorders and random behavior, Holmes points out.

"If nothing else, from a pragmatic viewpoint, this places a greater burden on caregivers," he says. "In an even more general sense, we know that depression can impact morbidity and mortality."

He suggests that case managers provide caregivers, both family members and health care professionals, with materials on recognizing depression. "Provide them with a depression checklist, and if they suspect depression, refer them to a geriatric psychiatrist."